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General NPI Number Information
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NPI Number | 1962921841
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Entity Type | Organization
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Legal Business Name | DAN V SANDRU MD LLC
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Dates
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Enumeration Date | 09/12/2017
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Last Update Date | 09/12/2017
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Provider Practice Location Address
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Address Line | 389 N COUNTY LINE RD
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City | JACKSON
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State | NJ
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Zip | 08527-4426
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Country | US
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Telephone | 908-330-7463
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Fax |
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Provider Business Mailing Address
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Address Line | 511 HARTSHORNE CT
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City | FREEHOLD
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State | NJ
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Zip | 07728-8214
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Country | US
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Telephone | 908-330-7463
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. DAN VICTOR SANDRU
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Credential | MD
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Telephone | 908-330-7463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 26NJ00741600
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License Number State | NJ
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